Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses

Abstract

Aim:To assess the health-care needs of the patients with severe mental disorders.Materials and Methods:Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS).Results:The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid.Conclusion:About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

“…Though comparison with other studies was difficult because of differences in patient-samples, methodology and assessment instruments, the mean number of total needs among patients with BD of the present study was quite similar to previous reports of patients with either BD[23-25], or severe mental illnesses including BD[9,18,22,26-28]. Combining the findings of the CAN-R and the scale for additional evaluation of needs suggested that needs were most frequently expressed in three or four broad clusters.…”

“…The average number of total needs reported by the patients themselves on the CAN-R was about six, which fell within the range of 4 to 10 needs reported by patients with severe mental illnesses on the CAN-R[18,20-22]. Though comparison with other studies was difficult because of differences in patient-samples, methodology and assessment instruments, the mean number of total needs among patients with BD of the present study was quite similar to previous reports of patients with either BD[23-25], or severe mental illnesses including BD[9,18,22,26-28].…”

“…The structure and scoring pattern of this instrument was similar to the CAN-R, but it had 21 items/areas not covered by the CAN-R. This scale has been used in a multi-centric Indian study on needs of patients with severe mental illnesses[18]. Finally, the level of functioning of patients was assessed using the Global Assessment of Functioning Scale (GAF)[11] and their QOL using the World Health Organization Quality Of Life-BREF version in Hindi (WHOQOL-BREF)[19].…”

Subjective distress in a representative sample of outpatients with psychotic disorders

“…This proportion is smaller than the prevalence of over 50% found in other studies using the CAN with psychosis patients (Bengtsson-Tops and Hansson, 1999;Grover et al, 2015;McCrone et al, 2001). This might be explained by the higher chronicity in the sample (with a mean duration of psychosis of 18 years), which is recognised to be more distressing in the early stages, given the traumatic disruption caused in life (Birchwood, 2003;Tarrier et al, 2007).…”

“…The few studies assessing subjective distress identify it as one of the most prevalent needs, present in 50% or more of patients with psychotic disorders, and among the most common unmet needs (Bengtsson-Tops and Hansson, 1999;Grover et al, 2015;Landolt et al, 2012;Thornicroft et al, 2004). It is a predictor of worse quality of life (Ritsner et al, 2006;Ritsner et al, 2012), and has been associated with more severe psychopathology (Bradshaw and Brekke, 1999;Hartley et al, 2013) and increased insight (Cooke et al, 2007;Selten et al, 2000).…”